Foot pain in rheumatoid arthritis prevalence, risk factors and management: an epidemiological study

Abstract

Foot involvement is a major feature of rheumatoid arthritis (RA). Most epidemiological studies of the RA foot report radiological changes and results of clinical examination. This study aimed to determine the prevalence of foot symptoms, frequency of foot assessment and access to foot care from the perspective of people with RA. A questionnaire was sent to 1,040 people with RA throughout the UK enquiring about foot symptoms, their anatomical distribution (via validated mannequins) availability of podiatry services and perceived usefulness of interventions for alleviating foot symptoms. Altogether 585 useable replies were received; 93.5% of respondents reported having experienced foot pain, and 35.4% reported current foot pain as the presenting symptom. Most (68.2%) reported moderate or severe foot pain daily. Pain was most prevalent in the forefoot and/or ankle. The main predictive factors for reporting current foot pain were longer disease duration (mean 13 vs 10.3 years, p = 0.009), higher BMI (25.6 vs 24.1 p = 0.001) and the prevalent foot symptoms foot stiffness and numbness (both p < 0.0001). Age, gender and current treatment were not significantly associated. Most (82%) had discussed foot symptoms with their rheumatologist, and only 64% had seen a podiatrist. Reported current adherence to prescribed orthoses was 55.8% and to prescribed shoes was 29.5%. Foot symptoms are ubiquitous in RA and frequently severe. Most patients had discussed their symptoms with their rheumatologist, and only 64% had specifically seen a podiatrist. Despite the remarkable progress in development of new treatment modalities for RA, foot pain remains a common and disabling symptom. Our findings support the need for wider access to specific foot care services and evidence-based, patient-centred interventions.

Fear of falling and foot pain, impairment and disability in rheumatoid arthritis: a case-control study

“…The women with an increased fear of falling demonstrated greater foot impairment, disability and more comorbid conditions. The differences in foot-related impairment and disability between cases and controls may have been attributed to factors that include lower limb muscle weakness [26], joint stiffness [25] or postural instability [23]. However, foot pain was not significantly different between the cases and controls.…”

“…We found no correlation found between fear of falling and foot pain. Foot pain is the most common problem facing people with RA both generally and specifically related to their feet [25]. However, all participants in the study were part of an ongoing foot care programme where they received regular general podiatric care that included the reduction of foot pain with the use of non-surgical interventions that included foot orthoses and footwear advice.…”

Comparison of foot pain and foot care among rheumatoid arthritis patients taking and not taking anti-TNFα therapy: an epidemiological study

“…Foot complaints are frequently seen in people with RA [3,4], and the extent of these pathologies contributes to the overall disability experienced [5]. Involvement of the foot in RA has been shown to be an important marker for impaired mobility and reduced functional capacity; this subsequent loss of mobility due to foot pathology can have a profoundly negative impact on social interaction [6][7][8].…”

Fear of falling, foot disability and disease activity in patients with rheumatoid arthritis

“…Several studies have demonstrated that foot problems in patients with rheumatoid arthritis (RA) are highly prevalent, even when classic measures of disease activity suggest clinical remission [20][21][22][23]. Despite great advances in disease management, a large majority of patients remain significantly impaired by foot complications [24].…”